Sensible goals are helpful, but they become a menace when meeting them is
treated as the only criterion of success

The neglect, cruelty and incompetence that characterised the way that so many patients at Stafford hospital were treated by its staff has been catalogued by Robert Francis’s inquiry, as we report today. Jeremy Hunt, the Health Secretary, is correct when he states that what happened in that hospital was “simply not worthy of a civilised country”.

The inquiry shows that the dismal, indeed lethal, performance was in large part a consequence of the way the Mid Staffordshire NHS Foundation Trust was managed. Its executives – determined to achieve the “foundation” status that had the critical advantage of enabling them to pay themselves larger bonuses – cut nursing staff to the point where it became impossible to deliver adequate care. To meet targets for foundation trust status, nurses were forced drastically to reduce the time they spent with patients. And yet not one of those executives responsible for the debacle has been barred from working in NHS management – and many of them hold key roles in the health sector. The Francis inquiry is likely to recommend a system of regulation for NHS managers: this might mean they would be “struck off” for performing below a minimum standard. The sooner that happens, the better.

The report also highlights the extent to which the system that is supposed to monitor standards in hospitals failed at the trust. Admittedly, this was partly because managers discouraged honest accounts of what was happening, threatening doctors and nurses who tried to put patients before targets with the sack. But it was also because the regulators were too sympathetic to the managers, and too focused on finance and targets, instead of care. It is imperative, as the Francis report will say, that the regulators’ attitude changes: they need to be genuinely independent, and put the safety of patients ahead of the interests of managers.

Could the horror of Staffordshire happen elsewhere? We agree wholeheartedly with Mr Hunt when he writes of the “vast majority” of NHS workers who joined because of their “innate compassion and humanity”. Yet, it is also true that the failings that led to this disaster were not due to a few “bad apples” among the management or nursing staff. They were a consequence of the system, and the incentives it gave for mindless compliance with centrally issued directives rather than caring for patients.

Sensible goals are helpful, but they become a menace when meeting them is treated as the only criterion of success. Labour’s obsessive emphasis on targets militated against the acts of kindness that are essential to real care. The Coalition has started the process of reducing reliance upon them. But until perverse incentives are removed, the danger of patients being treated appallingly, as they were in Staffordshire, will remain.